Audit Specialist

🕒 4 days ago

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AdaptHealth

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2019

📦 Logistics

🏭 Manufacturing

🏥 Healthcare

Logistics • Manufacturing • Healthcare

AdaptHealth is a company that provides healthcare solutions with a focus on respiratory health, sleep health, diabetes health, and wellness at home. With a network of 671 locations in 47 states, AdaptHealth delivers 38,225 home medical supplies each day and holds 2,825 insurance contracts. The company is dedicated to empowering patients to live their best lives, offering products and services such as CPAP machines, oxygen supplies, diabetes supplies, and a variety of medical equipment. AdaptHealth is highly rated by its customers for fast, reliable, and courteous service. They emphasize patient care solutions that integrate seamlessly into daily life, supported by online support and fast shipping services. Their mission is to change lives by providing the necessary healthcare tools to patients nationwide.

📋 Description

• Maintain the process and timely response to billing compliance audits conducted by Medicare, Medicaid, and commercial health plans • Analyze health plan reimbursement policies for coverage and documentation requirements • Review patient file documentation for completeness and accuracy • Procure and retrieve required audit documentation • Initiate and respond to inquiries from Account Executives, operations teams, and physicians regarding supporting medical necessity documentation • Log and report audit inquiries, including prepayment audits, post-payment documentation requests, overpayment refund requests, medical necessity documentation and CERT audits, and other audit activity • Contact internal teams and physicians to obtain additional supporting medical necessity documents • Review documentation submitted for audits for completeness and accuracy • Report apparent issues to the supervisor and coordinate submission of required documentation • Complete required fields and notes in the proprietary audit application • Scan and upload audit requests, submissions, correspondence, findings, and results • Assist with tracking and reporting audit findings and results • Assist with implementing performance improvement programs related to billing and coding performance • Maintain confidentiality of audit projects and information

🎯 Requirements

• High School Diploma or equivalent • One (1) year of work-related experience in health care administrative, financial, or insurance customer services, claims, billing, call center, or management, regardless of industry • Senior level requires two (2) years of work-related experience and one (1) year of exact job experience • Exact job experience includes the listed audit-related tasks in a Medicare-certified HME, diabetic, pharmacy, or home medical supplies environment that routinely bills insurance • Knowledge of Medicare, Medicaid, and commercial health plan reimbursement methodologies and documentation requirements • Excellent verbal and written communication skills • Strong organization, attention to detail, problem-solving, and critical-thinking skills • Ability to prioritize tasks, manage multiple projects, and work independently • Ability to adapt and work effectively in a rapidly changing environment and on a team • Ability to read and interpret Medicare, Medicaid, and commercial health plan policy articles and procedure manuals • Ability to prepare routine reports and correspondence • Ability to speak effectively before groups of employees • Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages • Ability to apply concepts of basic statistics • Ability to apply common-sense understanding to carry out written, oral, or diagrammed instructions • Ability to deal with problems involving several concrete variables in standardized situations • Strong proficiency in Microsoft Office, including Excel, Word, and Outlook

🏖️ Benefits

• Full-time employment • Remote work arrangement